Although debate continued in the Assembly as of press time, Thursday March 15 marked the last general business session day for the 2011-12 Wisconsin Legislature. An expected final flurry of activity over the last few weeks had all eyes focused on mining legislation that ultimately did not receive legislative approval. A few closely watched WHA-supported health care items ultimately passed or were expected to pass both houses, as did the biennial workers compensation advisory council bill and a measure to lift the cap on Family Care. Unfortunately, a few other sought-after proposals failed to advance.

The Legislature gave final approval to Assembly Bill (AB) 508, authored by Representative Scott Krug (R-Wisconsin Rapids). The bill, among other things, clarifies lending requirements related to cross-border projects for certain entities, including hospitals, seeking assistance from the Wisconsin Health and Educational Facilities Authority (WHEFA).

A measure that would enhance the state’s third-party liability identification efforts and help ensure Medicaid is the payer of last resort was awaiting final consideration in the Assembly at press time. Senate Bill (SB) 487, authored by Senator Pam Galloway (R-Wausau) and Rep. John Nygren (R-Marinette), aligns Wisconsin law with federal law to require both self-insured health plans and pharmacy benefit managers to be held to the same requirements as other third-party entities with respect to Medicaid reporting requirements.

The Biennial Worker’s Compensation Advisory Council bill (SB 409) that will head to the Governor’s desk establishes the maximum fee for health care services provided to injured workers at 1.2 rather than 1.4 standard deviations above the mean charge, using the current certified databases to establish the maximum fee. It also requires a committee of the WCAC to audit the certified databases for compliance with program requirements. If the required audit does not commence within six months of the date of the bill’s enactment, the maximum fee increases to 1.3 standard deviations above the mean charge. The bill also includes an increase in payments to injured workers who are permanently partially disabled.

Senate concurs on bill lifting Family Care cap

The Senate concurred in SB 380, a bill that would lift the Family Care enrollment cap. SB 380 had previously passed the Senate, but an amendment added in the Assembly requires Joint Finance Committee (JFC) approval before the program could be expanded.

Prior to the implementation of the program cap in last year’s state budget, the Family Care program could be expanded to new counties under a 14-day "passive" approval by the JFC. This meant that expansions could be approved without the Committee ever holding a hearing. Under the amendment, the JFC must hold a hearing and actively approve any expansions. The amendment does not include any timeline for the JFC to take action.

SB 380 is now available for consideration by Governor Walker who is expected to sign the measure.

Apology, workforce survey bills stall

One noted proposal that ultimately stalled was the Apology Bill, SB 103 / AB 147. The bills, introduced by Sen. Galloway, and Reps. Erik Severson, MD (R-Star Prairie) and John Nygren would protect statements of apology by health care providers to patients and families from being used against the provider in a medical malpractice lawsuit.

WHA testified in support of the bills at public hearings explaining that when a health care outcome is not what was planned or expected, a heartfelt statement of concern or apology can be very helpful for all involved (see previous Valued Voice story at
www.wha.org/pubArchive/valued_voice/vv6-3-11.htm#1).

The measure passed out of committee in the Senate, but became bogged down when questions were raised about the scope of statements protected under the bill. The proposal’s authors and others wanted the language to remain as broad as possible.

Another WHA-supported measure not advancing was SB 450, which would have created a requirement that dentists, dental hygienists, physicians, psychologists, physical therapists, physician assistants, pharmacists, and clinical social workers provide workforce data as part of their license renewal process.

WHA testified in support of the proposal (see previous Valued Voice story at
www.wha.org/pubArchive/valued_voice/vv2-24-12.htm#5) that was a Joint Legislative Council bill introduced as a work product of the 2010 Interim Legislative Council Study Committee on Health Care Access.

A Department of Workforce Development (DWD) fiscal estimate on the bill exceeded one million dollars but did not take into account much development work for nursing and medical provider surveys that has already been completed. While time has run out for this session, WHA continues to work with DWD and legislators on alternative strategies for workforce surveys.

Zorbini Appointed to Workforce Readiness Council

John M. Zorbini, senior vice president and chief human resources officer, Aurora Health Care, has been appointed by Governor Walker to serve on the Wisconsin College and Workforce Readiness Council.

Governor Walker created the Council earlier this year by Executive Order to recommend policies and programs to improve students’ college and career readiness and support job creation and economic growth in Wisconsin.

Nominated by WHA, Zorbini is a long-time member of the WHA Workforce Council. He has been an active member of WiSHHRA and has a history of community activity focused on educational preparation.

The first meeting of the Council will be held in April.

O’Keefe Re-Appointment to Rural Health Development Council Confirmed

On March 13, the Wisconsin Senate unanimously confirmed the re-appointment of Jim O’Keefe, president and CEO of Mile Bluff Medical Center in Mauston, to the Rural Health Development Council.

Created in 1989, the Council makes recommendations on ways to improve the delivery of health care in rural communities and on ways to coordinate the policies of state and federal programs relating to rural health care delivery.

The Council also provides advice on matters related to the Wisconsin Loan Assistance Program for physicians, dentists, dental hygienists, and non-physician providers such as nurse practitioners, physician assistants, and certified nurse mid-wives and on ways to evaluate the linkages between rural health facilities and economic development.

Governor Walker reappointed O’Keefe to the Council to continue as a representative of a health care facility located in a rural area with a term expiring July 1, 2016.

The Legislature still has limited-business floor period days scheduled where they can act on a restricted list of items such as appointments, revisions or corrections to bills already passed and resolutions extending commendations, condolences or congratulations. There are also days set aside to review any potential vetoes from Governor Walker.

Watch for a complete wrap up of the 2011-12 legislative session coming soon.

Early in their discussions, the WHA Graduate Medical Education (GME) Task Force felt they needed to understand how hospitals are reimbursed for providing direct and indirect graduate medical education (DME and IME) in order to determine how best to grow the number of medical residencies in Wisconsin.

At the Task Force meeting March 6 in Madison, Michael Everson, director of reimbursement for Froedtert Health, presented what he called a "Medicare GME Primer."

Everson explained the difference between DME and IME payments. DME is a payment for Medicare’s share of the costs of training physicians, including resident salaries and fringe benefits, supervisory physician compensation, and program administration and overhead costs. The payment is the product of the hospital’s per resident amount (PRA), Medicare utilization rate, and the number of full-time equivalent (FTE) residents.

IME reimbursement recognizes that teaching hospitals have higher patient care costs due to treating sicker patients, offering more services and technology, and spending time training residents who are inherently less efficient at providing patient care than are more experienced physicians. This payment is the product of the hospital’s teaching intensity, DRG payments and the IME adjustment factor for the current fiscal year.

Two thirds of federal reimbursement for GME, currently approximately $10 billion a year, is in the form of IME payments with the remaining one third being paid as DME. This highlights the potential impact of the proposed federal budget cuts to IME funding.

Everson said Medicare establishes a limit on the number of FTE residents that it will reimburse a hospital for in a given year. For most hospitals, the cap is based on resident counts in Medicare cost reporting periods ending on or before 12/31/1996, which is the base year audit. The cap is specific to the hospital, not the program. A new teaching hospital’s cap is set in the third year of operation at the highest number of residents in any prior program year.

Medicare pays hospitals the DME bi-weekly based on historical information, if it is available. The IME is paid on each Medicare Acute PPS claim. All payments are reconciled to actual experience through the audit of the Medicare Cost Report for a given year.

A hospital receives the same payment for all residents, regardless of specialty; however, primary care currently is reimbursed about $5,000 higher than the other specialties to encourage physicians to go into primary care.

"From my perspective, a resident program is not a self-funded proposition from the Medicare or Medicaid side," Everson said. "If it is part of your mission, realize that there are costs that are not reimbursed."

To fully grasp the issue of medical residencies, it is essential to understand the accreditation process, which is an area of expertise for Ken Simons, MD, executive director of the Medical College of Wisconsin Affiliated Hospitals.

The Accreditation Council for Graduate Medical Education (ACGME) is a private, nonprofit council that evaluates and accredits residency programs in the United States. Established in 1981, the mission of the ACGME is to improve health care by assessing and advancing the quality of resident physicians’ education through exemplary accreditation.

In academic year 2010-2011, there were 8,887 ACGME-accredited residency programs in 133 specialties and subspecialties. The number of active full-time and part-time residents during that time period was 113,142. The ACGME reviews and where appropriate, approves proposals for new types of programs in graduate medical education for which accreditation is being sought and periodically reviews the criteria by which programs in graduate medical education are evaluated.

Simons also described the National Resident Matching Program (NRMP). NRMP is a private, not-for-profit corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education (GME).

Simons said the NRMP is not an application processing service; rather, it provides an impartial venue for matching applicants’ and programs’ preferences for each other consistently. Students rank order their residency program preferences. Programs similarly rank order their applicant preferences and the NRMP matches their choices with the student’s preferences, giving greatest weight to students’ choices. Each year, approximately 16,000 U.S. medical school students participate in the Main Residency Match. In addition, another 20,000 "independent" applicants compete for the approximately 25,000 available residency positions. Independent applicants include former graduates of U.S. medical schools, U.S. osteopathic students and graduates, Canadian students and graduates, and students and graduates of international medical schools.

In 2010, the NRMP enrolled 4,176 programs in The Match, which altogether offered 25,520 positions. A total of 37,556 applicants participated in The Match. Of those, 16,427 were 2010 graduates of accredited U.S. medical schools and 21,129 were independent applicants.

Recognizing the importance of training Residents in Wisconsin in terms of recruitment of physicians to practice in our state, Task Force members agreed that if the Medical College’s plan to expand medical education and train possibly 100 more medical students in Wisconsin, it would be a "game changer" in terms of the number of residencies that would be necessary to keep these medical school graduates here.

Task Force member Michael Kryda, MD, vice president, medical affairs, Ministry Health Care, said collaboration is preferable, instead of competition, because "we could train more medical students, in perhaps more rural areas, by utilizing an infrastructure that would create some kind of utility that all health care organizations could take advantage of."

Ministry St. Joseph’s Hospital promises to keep its patients first in everything it does. In this way we know our patients will receive the best care possible. One way we can impact this care is by making sure our voices are heard in Madison and Washington, DC on policies that affect the hospital and patient care.

Ministry Health Care works together as one ministry in advocating in Madison and DC. We are tireless in this effort. The commitment can be seen in our nurses, staff members, board members, physicians, volunteers and the list goes on. These are the individuals who do the heavy lifting by establishing relationships with their legislators, by communicating with their elected officials on important issues and by collectively raising their voices on behalf of hospitals and communities. Throughout our organization, the importance of advocacy can be seen and felt.

This is one of the reasons I attend, support and believe in WHA’s annual Advocacy Day. It is the one day each year we as health care providers from across the state can stand side-by-side and speak with one voice to our elected officials. We know our voices do matter.

Participating in our government needs to be an integral part of what we do not just annually, but day to day. I know we are all very busy, but building relationships with policymakers who impact our future will take a fraction of that time yet matter more than ever in today’s environment.

I want to commend everyone who attends Advocacy Day every year. I stand with you in recognizing the importance of this event. To those who have yet to experience this valuable day, I encourage you to lend your voice to the cause.

This week WHA communicated with Ipsita Smolinski, president of the health care policy consulting firm Capitol Street in Washington, DC, about her sector-by-sector analysis of the sequester’s impact on Medicare providers. Using the Congressional Budget Office (CBO) updated baseline numbers for Medicare, Smolinski’s analysis reveals that hospital inpatient payments will take the biggest hit under sequester—a total of $33 billion over the next nine years.

After inpatient payments, Smolinski estimates the following cuts by sector:

Medicare Advantage with $27.5 billion in cuts

Physicians and Part B drugs at $16.34 billion

Part D at $14.76 billion

Hospital outpatient payments at $10.2 billion

Skilled nursing facilities at $6.35 billion

Home health at $4.55 billion

Long-term Care Acute Hospitals at $1.23 billion

Hospice at $3.07 billion

Dialysis at $2.34 billion

Durable medical equipment at $1.84 billion

Labs at $1.97 billion

"Due to the integrated nature of health care in Wisconsin," began Steve Brenton, WHA President, "not only will hospitals see significant cuts on the inpatient side, but also under physician payments, nursing home payments, outpatient, home health, hospice, labs and the list goes on."

Beginning in 2013, CBO’s figures show Medicare cuts at $4.6 billion under sequester with cuts increasing in size until 2021. Unless Congress acts to roll back the sequester process, it is set to begin January 1, 2013.

Smolinski has over 15 years of diversified health care experience, principally in U.S. health care policy research and consulting. Previously, Smolinski was the senior equity research analyst for health care policy at JPMorgan Chase.

Wisconsin, Iowa, and Minnesota received top grades in a first-ever Scorecard on Local Health System Performance, an undertaking of the Commonwealth Fund, a health policy focused foundation based in New York City.

The Scorecard focuses on four broad areas: access, quality, costs and patient outcomes. Wisconsin communities rank high. Appleton, Neenah, Green Bay, La Crosse and Madison all rank in the Top 10 percent of Local Areas. All Wisconsin communities fall within the upper 25 percent quartile.

There are numerous reasons that Wisconsin stands out, not the least being high rates of employer-based insurance coverage. Additionally, the state’s strong commitment to performance measurement, transparency and improvement undoubtedly helps drive these rankings.

Here’s a suggestion that this latest confirmation that we are "pretty good" leads us to recommit to advancing our already high status to the next level. There’s plenty of work to be done in several areas, including working with local employers to tame private sector health spending.

But the overall takeaway here is that "where you live matters" as it relates to health care. And the upper Midwest is a good place to live.

On Wednesday, March 14, the Legislature’s Joint Finance Committee approved modifications to the Medicaid waiver that the Committee originally approved last Fall. DHS negotiations with CMS have resulted in changes to the policy regarding premiums to be charged to Medicaid recipients. In Wednesday’s action, the Joint Finance Committee approved the premium changes. Upon final CMS approval, the Department expects to implement the premiums beginning July 1 of this year.

Original plans were for premiums to be charged to adults and children in families with income above 150 percent of the federal poverty level ($34,575 for a family of four). The premium amount would have been equal to five percent of the family’s income. Under the new policy, premiums would be applied to adults only—not to children—in households with income above 133 percent of the federal poverty level ($30,657 for a family of four). The premium amount would be on a sliding scale between 3 percent and 6.3 percent of household income. The new premium schedule mirrors the premium costs that would be imposed on families under the Patient Protection and Affordable Care Act (PPACA).

Dennis Smith, Department of Health Services (DHS) Secretary, fielded questions from Committee members. DHS estimates the new premiums would apply to nearly 44,000 recipients, and that approximately 10,200 of those individuals would choose to leave the program in response to the premium increase. Democrats on the Committee expressed concern about the impact on these recipients and the potential "hidden tax" if those individuals do not obtain coverage in the private sector.

In response, Secretary Smith noted that Wisconsin is using the same standard as the federal government for what is affordable health care. "If the standard of what we are looking for is access to affordable health insurance, this proposal meets that standard," he said. He further stated, "If we are wrong, then the entire PPACA is wrong."

Other aspects of the Department’s proposals—including medical home models and moving over 200,000 recipients from the standard plan to the benchmark plan—are still under discussion with CMS. Representative Cory Mason (D-Racine) asked Secretary Smith about the status of the proposed $100 emergency room
co-payment. Secretary Smith noted that CMS had denied a similar proposal in California and suggested that the state would probably not receive approval for the
co-payment policy.

After the Committee’s actions, the latest estimate of the base Medicaid shortfall is $55.8 million in state funds. The Department is expected to provide its next quarterly report of the status of the Medicaid program to the Joint Finance Committee by the end of the month.

A memo from the Legislative Fiscal Bureau (LFB) also outlined the status of other waiver policies that were approved by the Joint Finance Committee last Fall. After accounting for all of the changes to the waiver provisions, DHS projects about 22,800 people would no longer be covered under the Medicaid program. This estimate is down from nearly 65,000 under their original waiver proposal.

A quick look at the status of other waiver policies:

A 9.5 percent "affordability test" – Would apply only to adults, not to core plan. Estimated to begin July 2012.

12-month disenrollment for failure to pay premium – Would apply only to adults. Estimated to begin July 2012.

Terminating coverage for 19-26 year olds who have access to parent’s insurance – Not actively being negotiated with CMS.

Expedited disenrollment when participant is deemed ineligible (10 days after notice instead of the end of the month) – Estimated to begin July 1, 2012.

Elimination of retroactive eligibility – This item is still actively being negotiated with CMS.

Elimination of presumptive eligibility for children – This proposal has been withdrawn.

Counting income of all adults in household – This proposal has been withdrawn

Verification of state residency – DHS is still negotiating this policy with CMS

Elimination of transitional Medicaid – This proposal has been withdrawn. Adult transitional Medicaid recipients would be subject to the premium policy.

On Monday, March 12, the Centers for Medicare and Medicaid Services (CMS) released the final rules on the establishment of health insurance Exchanges and qualified health plans. Also in late breaking news, CMS released today two additional final rules related to risk sharing in the Exchanges and implementation of new Medicaid eligibility standards in 2014.

The Exchange rule released on Monday covers the federal standards that states must meet if they elect to establish and operate an Exchange; outlines the minimum standards that health insurance issuers must meet to participate in an Exchange; and provides basic standards that employers must meet to participate in the small business health options program (SHOP).

The 644-page final rule puts in place many of the policies described in the proposed rule, which was released last summer. The rule is expected to be published in the Federal Register March 27. The final rule maintains that, by January 1, 2013, a state must show that it is likely the Exchange will be fully operational by October 1, 2013 in order to for CMS to conditionally approve the state-based Exchange. Without such approval, the state would not be able to implement its own Exchange for 2014, but would instead be required to have a federally-run Exchange. The final rules do not describe how a federally-run Exchange would operate.

Unlike the proposed rule, the final rule does not contain an official formal public review process of the state’s Exchange plan (now called the "Exchange Blueprint"). CMS indicated the formal process was removed out of a concern that it could delay implementation. However, a state Exchange would still be required to consult with stakeholders, including health care providers.

For state-based Exchanges, states are allowed to include providers on the Exchange governance board, even though some consumer advocates had argued the providers could have a conflict of interest and should be prohibited from official membership on the exchange board. CMS added a requirement that the governing board have at least one consumer representative.

The rule also addresses network adequacy, and provides state flexibility in this area. The rule requires that a qualified health plan maintain a provider network that is sufficient in number and types of providers to assure that all services will be accessible without unreasonable delay. Mental health and substance abuse providers are specifically included in this standard.

The final Exchange rule does not address some key aspects of the health insurance Exchange, including quality standards, or essential health benefits design and actuarial value. Although bulletins have been released on the essential health benefits design and actuarial value, it is expected that CMS will address all of these issues in future guidance and regulation. WHA continues to review the details of all of the recently released final rules.

This past week Rep. Reid Ribble (WI 8th CD) met with Ministry Health Care leaders, including Affinity Health System, at St. Elizabeth Hospital in Appleton. The meeting was an opportunity to discuss recent affiliation changes between the two entities, other recent developments by the two systems and provide insight into the challenges facing hospitals from federal reimbursement cuts.

Travis Andersen, President of St. Elizabeth Hospital, led the meeting with an overview of the recent affiliation and how it will help better position Ministry for accountable care and clinical integration. In February, Ministry assumed full ownership of Affinity Health System, which includes three hospitals, multiple clinics, a medical group and a health plan. Previously Ministry and Wheaton Franciscan Healthcare of Milwaukee each owned 50 percent of Affinity.

"The assumption of sole sponsorship by Ministry will extend our health care delivery footprint into a contiguous geographic market," noted Nick Desien, president and CEO of Ministry Health Care in a statement when affiliation was announced. "Sole sponsorship brings additional assets to Ministry’s delivery system, which will create cost-saving opportunities, provide additional medical management experience and infrastructure, and better position Ministry to address issues related to health care reform."

Andersen also provided information on Affinity’s recent collaboration with Children’s Hospital of Wisconsin and ThedaCare in creating a new organization to provide outpatient child and adolescent mental health services in the Fox Valley and surrounding areas. Ribble expressed support for the groundbreaking collaboration.

The group then talked with Ribble about the impact federal hospital reimbursement cuts will mean to his district. They provided a summary of the estimated impacts over the next 10 years hospitals will see from the health reform law and the sequester process. Those are estimated at $361 million to the hospitals in Rep. Ribble’s district.

"That’s what keeps me up at night," said Jeff Badger, CFO of Affinity when explaining the magnitude of cuts, let alone other proposed cuts that continue to be discussed by Congress.

Dr. Mark Kehrberg, chief medical officer of Affinity, rounded out the meeting by summarizing the Wisconsin Hospital Association report, "100 New Physicians a Year…An Imperative for
Wisconsin." The report provided an analysis of what is facing Wisconsin hospitals and what Ministry, Affinity and hospitals statewide are proactively trying to address.

"Your helping me understand the complexity of this work is very important," Rep. Ribble said in thanking the attendees for the information and opportunity to meet. The group expressed their appreciation for Ribble’s willingness to meet regularly and discuss priority hospital issues.

On March 5, 2012, the Health Resources and Services Administration ("HRSA") issued a new Program Notice ("Notice") that provides additional insight into the recent audits of entities participating in the 340B Program ("Covered Entities"). The Notice, which HRSA characterizes as a restatement of current policy, represents the clearest public statement to date of HRSA’s 340B Program audit strategy and procedures.

First, the Notice indicates that entities currently required to obtain an audit in accordance with the requirements of OMB Circular A-133 (Single Audit Act) will, in federal fiscal year 2013, be required to review 340B Program compliance as part of that annual audit.

Second, HRSA states in the Notice that it will also conduct "random and targeted" audits that will be more detailed than the A-133 audit requirements mentioned above. These targeted audits will include a "thorough investigation of policies and procedures, [and a] review of auditable records and system compliance to prevent diversion and duplicate discounts." Interestingly, HRSA stated that the audit protocol will be made publicly available at some point in the future. Not only will this protocol assist in preparing for potential audits, but it may provide desired guidance regarding 340B Program standards generally.

The 340B Program Covered Entities at highest risk of being audited will be those "[with] higher program risk due to volume of purchases, [with] increased complexity of program administration, and [who] use contract pharmacies." Interestingly, HRSA also states that audits may be triggered by allegations of 340B Program violations made by anyone and not just whistleblowers, manufacturers or covered entities themselves.

These pending audits, though potentially burdensome to the audited Covered Entity, may not be all bad. As HRSA has noted, current 340B Program guidance is sometimes not specific enough to define situations under which individuals are considered to be Covered Entity patients as required to dispense discounted drugs under 340B Program standards. Many 340B Program Covered Entities are therefore looking to the results of these audits to provide much needed clarity surrounding 340B Program standards.

Moving forward, Covered Entities (especially 340B Program participating hospitals with high outpatient volumes or large-scale contract pharmacy implementations) may want to revisit their 340B Program compliance mechanisms, paying particular attention to eligible patient definitions and to contract pharmacy implementation mechanisms. Where questions that may be open to interpretation arise, it may make sense to take a more conservative approach pending the outcome of the HRSA 340B Program audits.

In recognition of persistent rates of high unemployment, the growing number of uninsured individuals, and the pressing health needs in the community, Milwaukee’s five health systems are continuing financial support to the city’s Federally Qualified Health Centers (FQHCs) for the care of uninsured patients. In 2012, Aurora Health Care, Children’s Hospital and Health System, Columbia St. Mary’s, Froedtert Health and Wheaton Franciscan Healthcare will provide $1.7 million to FQHCs to help cover the costs of primary care and emergency department (ED) care management services for low income patients without insurance.

Last year, Milwaukee’s FQHCs—Milwaukee Health Services, Inc., Outreach Community Health Centers, Sixteenth Community Health Center and Progressive Community Health Centers—recorded over 45,000 medical visits for patients without insurance. Additionally, they received over 7,000 patient referrals from area emergency departments via the Milwaukee Health Care Partnership ("Partnership") ED to Medical Home initiative. Although the health centers receive some federal funding to subsidize care for low income people without insurance, the public funding is insufficient to cover the total cost of care. In 2011, almost one-third of the patients seen at Milwaukee’s FQHCs had no insurance, most of who were at or below the federal poverty level.

Health systems’ financial support to FQHCs has been coordinated through the Partnership, a public/private consortium dedicated to improving care for underserved populations in Milwaukee County.

"Milwaukee’s FQHCs do a tremendous job caring for low income and uninsured patients," says Bill Petasnick, the Partnership’s board chair and CEO of Froedtert Health. "They provide a comprehensive range of primary care, dental and behavioral health services along with care management and support services such as transportation and interpretation. They play a critical role in our community and in the Partnership."

Recognizing the value of FQHCs in improving the health of vulnerable populations, the United Way of Greater Milwaukee (UWGM) leveraged the health systems’ commitment in its 2011 campaign. "We were delighted that the health systems agreed to direct their $1.7 million support through United Way," says Mary Lou Young, UWGM president and CEO. "Access to health care is one of our core focus areas and aligns with our mission. With the dollars going through United Way, we were able to secure an additional $302,739 from our network of donors and elevate the important work of FQHCs in meeting basic needs in our community."

In addition to funding to subsidize medical homes and care management for the uninsured, in 2011 the health systems collectively contributed an additional $1.1 million to improve coverage, access and care coordination, including funding for community needs assessment and planning, insurance enrollment outreach, health information technology, specialty access and ED care coordination. These shared community investments are over and above the unique community contributions made by the individual health systems and their combined $377 million in charity and uncompensated care in 2010.

WHA’s Aligning Forces for Quality Initiative, in collaboration with the WHA Information Center, has recently invited all member hospitals, ambulatory surgery centers and quality coordinators to participate in a free webinar to be held Wednesday, March 21, 2012 from 9:30-11:00 a.m. to review the importance and administrative requirements of collecting race and ethnicity data.

Hospitals, ambulatory surgery centers and other health care delivery systems play a major role in a community’s health care system and their infrastructure for collecting and using race and ethnicity data. Accurate race and ethnicity data has been used to document important differences in access between racial and ethnic groups. In addition, valid and reliable race and ethnicity data is important in a number of health care initiatives not only on a state and local level, but also on a federal level. This information is used to determine if there are disparities in care due to race and ethnicity, and helps to improve the quality of care delivered to specific populations across the nation.

We look forward to working with our partner facilities to help improve the collection and reporting of race and ethnicity.

The Wisconsin Hospital Emergency Preparedness Program (WHEPP), in coordination with the Wisconsin Hospital Association, is sponsoring a one-day hospital public Information officer seminar in two locations: May 1, 2012 in Madison and May 2, 2012 in Wausau. The seminar will be identical in content each of the two days it is being offered.

David Morris, who was the public information officer at Mercy Regional in Joplin, Missouri when the hospital was hit by a major tornado that ripped the facility apart, will give a presentation.

The seminar will be facilitated by Gerard Braud, an expert in media issues and crisis communications. He is an international media trainer, author and speaker who has worked with organizations on five continents. Braud has been active in the field of communications since 1979. He has worked in print, radio and television as a front line journalist. His affiliate reports have been seen around the world on NBC, CBS, CNN and the BBC.

The seminars are intended for public information officers, specifically from hospitals, that would like an intermediate-level overview of writing crisis communications plans and learning how to more effectively communicate with media and their communities.

There is no cost for this one-day seminar, however, registration is required. To register, go to
www.TRAIN.org, log in, and click on "Course Search." Search by Course ID on the left side and enter Course ID #1032697 (The course is titled "Hospital Public Information Officer Seminars.")

Note: Prior to registration, you must create an account on TRAIN, the statewide public health online training portal, if you do not already have an account. To create an account, go to
www.TRAIN.org and follow these steps:

Select your location above the "Create Account" button on the left side.

Click on "Create Account," underneath the login on the left hand side of the screen.

The Board of Directors of Memorial Medical Center in Neillsville has announced the appointment of Bobbe Teigen as the next chief executive officer.

Teigen comes to Neillsville from Payneville, Minnesota, where she served as CEO for the Payneville Area Health Care Systems since 2009. Prior to her time in Minnesota, she was in Wisconsin as chief administrative officer at Aurora Health Care, and as CEO for Sauk Prairie Memorial Hospital. She has a master’s degree in health care administration from Cardinal Stritch College in Milwaukee, and a bachelor’s degree in education.

She is a past board president for the Rural Wisconsin Health Cooperative and Fellow of the American College of Health Care Executives. While in Wisconsin, she was very active in the Wisconsin Hospital Association, serving on the Councils on Rural Health, Public Policy, Medical & Professional Affairs, and Workforce Development. She also served on the WHA Board and Executive Committee, and on the WHAFS Board.

A teen arrives in the emergency department by ambulance following a terrible car accident. A child receives head injuries while bicycling without a helmet. A woman walks into the emergency department with injuries inflicted by an abusive spouse. These are stories of pain and tragedy that hospital personnel see all too often. Injury is the most under recognized major public health problem facing the country and it is the leading cause of death in people ages 1 to 44 in Wisconsin. Wisconsin hospitals devote significant resources to reduce the number of intentional and unintentional injuries that occur in the communities they serve.

Babysitting and Beyond

As summer approaches, many teens are at left home to watch and care for their younger siblings. Why not teach those teens to be responsible babysitters?

Nicole Hendrikse, patient education coordinator at Aurora Sheboygan Memorial Medical Center, and a devoted mother of four small children, set out to develop a babysitting training program to teach young people how to make good, responsible decisions while keeping children in their safe care. Nicole has a passion to prepare a babysitter she would trust with her own children by providing key education.

Babysitting and Beyond continues to be offered by popular demand. This year, Nicole conducted two after-school programs in Oostburg Elementary attended by a total of 34 fifth-graders from Oostburg and seven fifth-graders from Holy Family.

To develop the curriculum, Nicole met with 7th graders who went through other babysitting training programs to learn what they liked—and to uncover what they wanted to learn, but didn’t. Seeing their needs through their eyes helped her formulate an approach of teaching the course at their level. Students learned that there are the different stages of development from babies to toddlers. They learned activities such as proper feeding, safety and what to do when there is an emergency.

Additionally, Nicole incorporated the American Health Association (AHA) Family and Friends CPR instruction and basic first aid.

When the students complete their class they receive a folder, t-shirt, bag, plus both AHA First Aid and CPR and Babysitting and Beyond certificates.

Aurora Sheboygan Memorial Medical Center, Sheboygan

Reviving a life-saving tradition, with a twist

When Barbara witnessed her father’s collapse two years ago, the only way she could help was by calling 911. Today, after a simple 15-minute training in compression-only CPR (COCPR), she realizes that her newfound knowledge might have kept her father alive.

Barbara is among more than 1,000 people who took part in the first community-wide Hands on Hearts education event sponsored by St. Mary’s and other community partners. The free COCPR training, which was available at ten convenient locations in and around Madison, was provided in hopes of increasing survival rates for adults whose hearts suddenly stop beating.

Since COCPR began to be used in Dane County, the survival rate for cardiac arrest patients went from a meager 17 percent to 38 percent—a doubling of success so far.

COCPR is easier to learn and more palatable than traditional CPR, which requires rescue breaths amid each cycle of compressions. Surveys show that most people are not comfortable with giving breaths, especially to strangers, and that removal of this barrier still yields the same life-saving benefits.

St. Mary’s Hospital, Madison

Safer two-wheeling and sidewalk surfing: helping kids-on-the-go

Be it by skateboard or bicycle, area youth enjoy kid-powered transportation. Monroe Clinic strives to support kids-on-the-go by partnering with community friends to offer the tools they need to stay safe and active.

Each year, when the City of Monroe’s Parks and Recreation hosts a "SK8 Clinic" with Monroe Area Skatepark Enthusiasts (M.A.S.E.) to teach new skaters safety skills and basic skateboard maneuvers, Monroe Clinic donates helmets and pads as a registration incentive.

"Skateboarding can be a very safe sport with the right tools and information. It actually has fewer injuries per 1,000 participants than football, basketball, baseball or soccer. I’ve had numerous parents thank us for furnishing helmets and pads, which Monroe Clinic has donated for the past three years," said Tom Miller, SK8 Clinic organizer.

Monroe Clinic has also joined with area park districts and service organizations to encourage safe bicycling by donating helmets and other safety equipment for use in community bike rodeos. According to the Wisconsin Department of Transportation, every bicyclist wearing a helmet correctly each time they get on a bicycle can help prevent more than 85 percent of head injuries when crashes do happen. While the promise of free helmets may attract participants to these events, it also helps protect young riders long after the bike rodeo is over.

"My son had an older helmet, but we learned it was no longer well-fitted and posed some risks. So not only did he leave with a lot of good information on how to ride safely, but he also received a new, properly fitted helmet to protect all that newfound knowledge," said parent Tabitha Engel, who also helped organize one of the area bike rodeos as a member of the local Jaycees chapter.

She added, "I know the cost of a new helmet can be off-putting for some families who are just trying to make ends meet. This donation may prevent serious injuries for any one of these children."

Monroe Clinic, Monroe

Getting the most protection from child safety seats

Motor vehicle crashes are the number one cause of death for children. The problem, in part, is that an estimated four out of five children in child safety seats are not buckled in properly. Parents shouldn’t wonder—and worry—if their children are safely restrained. So every year, the Safe Kids Coalition of the La Crosse Coulee Region, led by Gundersen Lutheran, sponsors free child safety seat checkup events in partnership with the La Crosse County Health Department and other area organizations such as La Crosse School District, Head Start, YMCA, local police and departments, Hmong Community Center and others.

At the events, child passenger safety technicians check all child safety seats to be sure they are properly installed in the car. In addition, with the child present, technicians check to see that the child is properly fitted and secured into the car seats. Parents can also learn how booster seats are used to make safety belts fit children correctly.

A young adult female, developmentally disabled, was referred to the Sexual Assault Nurse Examiner (SANE) program at Waukesha Memorial Hospital by our County’s adult protective services. The adult day care center she attended recognized acute deterioration in her behavior and hygiene that led them to suspect potential abuse. The case was complicated by the fact that her guardian father was the suspect. The adult day care center contacted the police and adult protective services who in turn referred her to The Care Center, a volunteer agency which is highly skilled at interviewing pediatric victims of abuse. Because she was of an adult age, they were not able to complete a medical and forensic exam and therefore referred her to our program. Our SANEs provided the compassionate and patient-centered care required in this very sensitive situation. Working collaboratively, these agencies were able to obtain the required consent, complete a very delicate interview and examination, treat the patient holistically and successfully remove the young woman from an abusive environment.